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CDC & ACOG Convene Meeting on Maternal Mortality & Maternal Safety in Chicago

May 23rd, 2014 by avatar
creative commons licensed (BY-NC-SA) flickr photo by Insight Imaging: John A Ryan Photography: http://flickr.com/photos/insightimaging/3709268648

creative commons licensed (BY-NC-SA) flickr photo by Insight Imaging: John A Ryan Photography: http://flickr.com/photos/insightimaging/3709268648

Earlier this week, I shared information on the Safety Action Series kickoff that all were invited to participate in, by the National Partnership for Maternal Safety – focused on reducing the maternal mortality ratio and morbidity ratio for mothers birthing in the U.S.  This partnership is part of the Council on Patient Safety in Women’s Health Care.  Last month Christine Morton, PhD and Robin Weiss, MPH attended a meeting as board members of Lamaze International.  Christine shares meeting notes and topics that were discussed and what maternity professionals, including childbirth educators,  can do to help. – Sharon Muza, Science & Sensibility Community Manager.

Disclosure:  Christine is a member of the Patient/Family Support Workgroup of the National Partnership for Maternal Safety, and a current board member of Lamaze International. 

Since 1986, the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) convened interested persons in public health, obstetrics and maternity care to discuss and share information about maternal mortality, including methodologies for pregnancy mortality surveillance at state and national levels, and opportunities to reduce preventable maternal deaths.   Recently, under leadership of Dr. Elliott Main, medical director of California Maternal Quality Care Collaborative (CMQCC), and drawing from the recent experience of California in maternal quality improvement and work by other organizations and collaboratives, the focus of the interest group has shifted from surveillance to quality improvement.  The meeting has evolved from the early years when 12-20 persons sat around tables to discuss the issue, to this year’s meeting which had over 180 persons registered.  Clearly the time has come for a coalition around improving maternity outcomes in the U.S.

The National Partnership for Maternal Safety was proposed in 2013 in New Orleans, and the goal of the April 27, 2014 meeting in Chicago was to formally launch the initiative and report on the progress of each work group. The goal of the National Partnership for Maternal Safety is for every birthing facility in the United States to have the three designated core Patient Safety Bundles (Hemorrhage; Venous Thromboembolus Prevention; and Preeclampsia) implemented within their facility within three years. The bundles will be rolled out consecutively, beginning with obstetric hemorrhage and advancing to the other areas. To support this national effort, publications are underway in peer-reviewed journals. The first article, as an editorial call to action, appears in the October 2013 issue of Obstetrics & Gynecology, the official publication of the American College of Obstetricians and Gynecologists.

Highlights from this year’s meeting included two presentations from CDC researchers William Callaghan, MD, MPH and Andreea Creanga, MD, PhD, on work being done to better identify cases of severe maternal morbidity (SMM) and drivers of racial/ethnic disparities.  One of the goals of creating a working definition of SMM is to help facilities track and review cases in order to identify systems issues and address them through quality improvement efforts.

Next, representatives from selected work groups (Hemorrhage; Venous Thromboembolus Prevention; Patient/Family Support) shared their updates.    It has become very clear from ongoing work within large hospital systems, state-based quality collaboratives and other countries such as the UK, that standardized protocols for recognition and response to preventable causes of mortality and morbidity are effective.  Unfortunately, there is no national requirement for all birthing facilities (hospitals and birth centers) to have updated policies and protocols on these preventable causes of maternal complications.

The good news is that there is a groundswell of support for a coordinated effort to realize the goals of the Initiative.  From state quality collaboratives in California, New York, Ohio and Florida to Hospital Engagement Networks, there are many hospitals already implementing some maternal quality improvement toolkits.  The Joint Commission plays a key role in helping hospitals work on patient safety issues and identified maternal mortality as a sentinel event in 2010 and is now proposing that any intrapartum (related to the birth process) maternal death or severe maternal morbidity should be reviewed.  As the nation’s largest accreditation body for hospitals, the Joint Commission is in a position to provide oversight as well as guidance to hospitals as they develop system-level reviews of these outcomes.

More states are being supported by federal and nonprofit agencies to develop and conduct maternal mortality reviews, and the role of Title V, the only federal program that focuses solely on improving the health of mothers and children, is critical.  Title V is administered by each state to support programs enhancing the well being of mothers and their children.

The last topics of the day were how to address the most common cause of maternal mortality – cardiovascular disease in pregnancy – but not as preventable as the three causes featured in the Initiative.

Suggested topics for future meetings including looking at maternal mortalities due to suicide, helping states with small populations aggregate their data, and addressing the issue of prescription (and other) drug abuse among pregnant women.  Eleni Tsigas from the Preeclampsia Foundation stressed the importance of including women’s perspectives and the emotional, social and ongoing physical sequelae of living after a severely complicated childbirth experience.

How is this information relevant for childbirth educators, doulas and other maternity professionals?  First, the rising rates of maternal mortality and morbidity are in the news.  While deaths are rare, severe complications are more common.  CBEs and doulas can reassure pregnant women in their classes that the likelihood of a severe morbidity is low, and can provide resources to share with women and help them learn which hospitals in their communities have begun the work of maternal quality improvement.  CBEs can share this information with key nursing and medical leaders at hospitals where they teach, and offer to help with the Quality Improvment (QI) efforts.

Childbirth educators and others can help ensure the focus not become too one sided – while it is important for every hospital to be ready for typical obstetric emergencies, it is also important for every hospital to be prepared to support women through normal physiologic birth by trained staff and supportive physicians. AWHONN launched its campaign, “Go the full 40” in January 2012 to help everyone remember that while we don’t want to ELECTIVELY deliver babies prior to 39 completed weeks gestation, we also want to support labor starting on its own.  And most recently, ACNM unveiled its BirthTOOLs site, which includes resources, tools and improvement stories on supporting physiologic, vaginal births.  CBEs and doulas can be strong advocates in supporting facility and maternity clinician preparedness for the ‘worst case’ and ‘best case’ scenarios in childbirth.

For more info about National Partnership for Maternal Safety or the CDC/ACOG Maternal Mortality Interest Group, please contact:  Jeanne Mahoney, jmahoney@acog.org

Past and future webinars about the initiative are available to the public here: http://www.safehealthcareforeverywoman.org/safety-action-series.html

Archived presentations from past CDC/ACOG maternal mortality interest group meetings

2014:  http://bit.ly/1sXkaGw

2012: http://bit.ly/1pfay9S

 

Childbirth Education, Guest Posts, Lamaze International, Maternal Mortality, Maternal Mortality Rate, Maternal Quality Improvement, Pregnancy Complications, Uncategorized , , , , ,

U.S. Maternal Mortality Ratio is Dismal, But Changes Underway, and You are Invited to Participate!

May 19th, 2014 by avatar
creative commons licensed (BY-NC-ND) flickr photo by lanskymob: http://flickr.com/photos/lanskymob/5965201901

CC  by lanskymob: http://flickr.com/photos/lanskymob/5965201901

Earlier this month a paper was published in The Lancet, “Global, regional, and national levels and causes of maternal mortality during 1990—2013: a systematic analysis for the Global Burden of Disease Study 2013” that used statistical methods to estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. (For comprehensive definitions of maternal mortality ratios as defined by different agencies, please see this link.)

While many countries experienced a decline in the maternal mortality ratio during the studied time period, the United States experienced a disturbing increase.  The U.S. was one of only eight countries to document an increase in maternal mortality in the past ten years.  Our current world ranking for maternal mortality is 60 out of 180 on the ranking list.  As a nation, we have lost considerable ground in the past 25 years.  Women in the USA are more than twice as likely to die as a result of a pregnancy or birth as mothers in Western Europe.

Researchers looking at the data estimate that 18.5 mothers died for every 100,000 births in the U.S. in 2013, a total of almost 800 deaths a year.  The reasons for these dismal numbers in the U.S are not clear.  Suggestions of inaccuracies in reporting, more mothers experiencing hypertension or diabetes during pregnancy, or women becoming pregnant who had serious preexisting health conditions, who in another time, might not have survived to become pregnant themselves are all suspected as contributing to our rate.

The National Partnership for Maternal Safety has been formed and is a multidisciplinary initiative focused on reducing the rates of maternal morbidity and mortality in the United States.  This partnership falls under the umbrella of The Council on Patient Safety in Women’s Health Care. This unique consortium of organizations across the spectrum of women’s health who have come together to promote safe health care for every woman.

maternal safety logo

The Council on Patient Safety in Women’s Health Care is sponsoring a Safety Action Series and the first one is to be kicked off this Tuesday, May 20, 2014. with a free teleconference at 11 AM EST, and all are invited to register.

The purpose of this first session is to share details of the National Partnership for Maternal Safety.  Debra Bingham, DrPH, RN, Vice President of Research, Education and Publications at the Association of Women’s Health, Obstetric & Neonatal Nurses and Vice Chair of the Council on Patient Safety in Women’s Health Care and Mary D’Alton, M.D., FACOG, Chair of the Department of Obstetrics & Gynecology, Maternal-Fetal Medicine at Columbia University Medical Center.

The session will include:

  • An overview of the purpose, composition, and goals of the Partnership
  • A look at how the activities of the Partnership align with national efforts to reduce maternal morbidity and mortality.
  • A summary of the future activities and deliverables of the Partnership.
  • Including a focus on obstetric hemorrhage, hypertension in pregnancy, and venous thromboembolism.
  • Supplemental materials on maternal early warning criteria (triggers); patient, staff, and family support, and severe maternal morbidity review and reporting.
  • An open Q&A session with Drs. Bingham and D’Alton.

Lamaze International Board Member Christine Morton, PhD attended The National Partnership for Maternal Safety meeting at the recent ACOG conference in Chicago, along with Lamaze President Elect Robin Weiss, MPH. Dr. Morton will summarize the meeting and share her takeaways on the multistakeholder consensus efforts to reduce maternal mortality in a follow up post later this week.

In the meantime, will you consider participating in the first Safety Action Series scheduled for May 20th and learn more about what we are doing as a nation to improve outcomes for pregnant and birthing women in the U.S.A.  Register now for this free teleconference.

References

Berg CJ, Callaghan WM, Syverson C, et al., Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010; 116: 1302-9.

Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., … & Basu, A. (2014). Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet.

Trends in Maternal Mortality, 1990-2010, WHO, UNICEF, UNFPA and The World Bank Estimates available at http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf.

ACOG, Maternal Mortality, Maternal Quality Improvement, Maternity Care, New Research , , , , ,

2014 Preeclampsia Awareness Survey Highlights Need for Education- Educators Play a Key Role

May 13th, 2014 by avatar

May is Preeclampsia Awareness Month and childbirth educators play a key role in informing families about the symptoms of this disease of pregnancy (or postpartum.) Eleni Tsigas, the Executive Director of The Preeclampsia Foundation shares the results of a recent survey quizzing women on their awareness of this potentially deadly disease.  CBEs and others have a responsibility to share information in a calm, factual way duing class so that women are informed but not scared, should this disease present itself during their childbearing year. – Sharon Muza, Community Manager, Science & Sensibility

Preeclampsia_Pledge

As Executive Director of the Preeclampsia Foundation®, the nation’s only patient advocacy organization for preeclampsia and related hypertensive disorders of pregnancy, I’m excited to announce the results of a recent nationwide Preeclampsia Awareness Survey of more than 1,500 expectant and new mothers. These survey findings are driving the Foundation’s strategies associated with National Preeclampsia Awareness Month this month.

The survey, which was conducted by BabyCenter®, shows a high overall awareness of preeclampsia and that it is serious and associated with high blood pressure. There was also near universal knowledge to call a healthcare provider if experiencing symptoms of preeclampsia.

We’re very encouraged by the awareness that’s been raised in recent years, in sharp contrast to our last study six years ago that found very low overall awareness of preeclampsia. But there’s more to do, because this year’s survey also shows low awareness when respondents were asked about specific symptoms associated with preeclampsia.

The more a pregnant woman knows about preeclampsia, the more likely she is to recognize and report symptoms to her doctor or midwife. That improves time to diagnosis and medical evaluation, which saves lives – for both mothers and babies. And that’s why we’re so focused on improving awareness of preeclampsia.

Preeclampsia and other hypertensive disorders of pregnancy remain a leading cause of maternal and infant illness and death. Globally, by conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths every year. In the United States, preeclampsia affects one in every 12 pregnancies, and its incidence has increased by 25 percent during the past two decades.

Key Survey Findings

The recent survey of 1,591 women shows high overall awareness of preeclampsia, its severity and link to high blood pressure, and to immediately report symptoms to their healthcare providers:

  • 83% of respondents had heard of preeclampsia and of those women, 99% knew that it is extremely serious, even life-threatening for mother and baby, very serious, or somewhat serious
  •  88% knew that high blood pressure is a sign of preeclampsia
  • 96% would call their doctor or midwife if they experienced symptoms

Results also show areas that the healthcare community needs to address:

  • Raise awareness of the specific symptoms associated with preeclampsia
    • 78% incorrectly linked preeclampsia to swelling of the feet
    • Only 70% correctly linked preeclampsia to headache and vision changes
    • 3 out of 5 women were not sure about several other symptoms
  • Educate women on when preeclampsia can occur and its long-term impact
    • 44% didn’t know that preeclampsia can occur even after the baby is delivered, up to six weeks postpartum
    • 46% didn’t know that women with preeclampsia are at risk for future health problems
  • Improve access to information, regardless of education or income level
    • Compared to the 83% of respondents in general who had heard of preeclampsia,
      • 51% with some high school education had heard of preeclampsia
      • 37% who earned under $25k a year had heard of preeclampsia

Download the Preeclampsia Infographic

Survey Findings Drive Education Campaign

Released in conjunction with Preeclampsia Awareness Month, the survey findings provided the basis of the Foundation’s education campaign launched this month. Its theme – Take the Preeclampsia Pledge: Know the Symptoms. Spread the Word – highlights the importance of early recognition and reporting of symptoms. The campaign features Promise Walks for Preeclampsia™ across the country, social media events, and an easy-to-understand and share video called Preeclampsia: 7 Symptoms Every Pregnant Woman Should Know. (Spanish version)


 Know the Symptoms. Spread the Word.

Early recognition and reporting of symptoms is the key to timely detection and management of preeclampsia. Women who are pregnant or recently delivered should contact their doctor or midwife right away if they experience any of the symptoms listed below, and healthcare providers should be appropriately responsive. While these symptoms don’t necessarily indicate preeclampsia, they are cause for concern and require immediate medical evaluation.

  • Swelling of the hands and face, especially around the eyes (swelling of the feet is more common in late pregnancy and probably not a sign of preeclampsia)
  • Weight gain of more than five pounds in a week
  • Headache that won’t go away, even after taking medication for pain relief
  • Changes in vision like seeing spots or flashing lights; partial or total loss of eyesight
  • Nausea or throwing up, especially suddenly, after mid pregnancy (not the morning sickness that many women experience in early pregnancy)
  • Upper right belly pain, sometimes mistaken for indigestion or the flu
  • Difficulty breathing, gasping, or panting
  • “I just don’t feel right”

It’s also important to know that some women with preeclampsia have NO symptoms. Healthcare providers can only diagnose preeclampsia by monitoring blood pressure and protein in the urine, which is routinely done at prenatal appointments, so keeping all appointments is vital throughout pregnancy and immediately after delivery.

About the Preeclampsia Awareness Survey

The survey was conducted among visitors to the BabyCenter® website from January 17 to January 20, 2014. A total of 1,591 respondents completed the survey; qualified respondents are defined as female U.S. residents, 18 years or older, who are pregnant or have at least one child three years of age or younger.

About the Preeclampsia Foundation

A U.S.-based 501(c)(3) non-profit organization established in 2000, the Preeclampsia Foundation is dedicated to providing patient support and education, raising public awareness, catalyzing research and improving health care practices, envisioning a world where preeclampsia and related hypertensive disorders of pregnancy no longer threaten the lives of mothers and babies. More information can be found at www.preeclampsia.org or by calling toll-free 800.665.9341.

How do you talk about preeclampsia in your childbirth classes?  When do you discuss it?  Are you also sharing that postpartum women can also develop this disease?  Would you consider showing the brief video above highlighting the seven key symptoms.  Let us know how you are discussing this topic in the comments section below. – SM

About Eleni Z. Tsigas 

eleni tsigas head shotEleni Z. Tsigas is the Executive Director of the Preeclampsia Foundation. Prior to this position, she served in a variety of volunteer capacities for the organization, including six years on the Board of Directors, two as its chairman. Working with dedicated volunteers, board members and professional staff, Eleni has helped lead the Foundation to its current position as a sustainable, mission-driven, results-oriented organization.

Eleni is married, and had has two of her three pregnancies seriously impacted by preeclampsia. As a preeclampsia survivor, she is a relentless champion for the improvement of patient and provider education and practices, for the catalytic role that patients can have to advance the science and status of maternal-infant health, and for the progress that can be realized by building global partnerships to improve patient outcomes.

Eleni has served as a technical advisor to the World Health Organization (WHO), is a member of the PRE-EMPT Technical Advisory Group and Knowledge Translation Committee (funded by the Gates Foundation), and participates in the Hypertension in Pregnancy Task Force created by the American College of Obstetricians and Gynecologists (ACOG), as well as a similar task force for the California Maternal Quality Care Collaborative (CMQCC). Eleni is frequently engaged as an expert representing the consumer perspective on preeclampsia at national and international meetings, and as a spokesperson in various public speaking venues. She was honored to deliver The Jim & Midge Breeden Lecture as part of ACOG’s 2012 Annual Clinical Meeting President’s Program.

Childbirth Education, Guest Posts, Maternal Mortality, Maternity Care, News about Pregnancy, Pre-eclampsia, Pregnancy Complications , , , ,

Thank You Midwives! Celebrate International Day of the Midwife Today!

May 5th, 2014 by avatar

2014 day of midwife_600pxMay 5th has been recognized as the International Day of the Midwife since 1992. The International Confederation of Midwives (ICM) supports, represents and works to strengthen professional associations of midwives throughout the world.  The purpose of this day is to “celebrate midwifery and to bring awareness of the importance of midwives’ work to as many people as possible.” There are currently 108 Midwives Associations, representing 95 countries across every continent. ICM is organized into four regions: Africa, the Americas, Asia Pacific and Europe. Together these associations represent more than 300,000 midwives globally.

Midwives play a crucial role in maternal and infant health.  This year’s theme is “Midwives: changing the world one family at a time.” There are many key messages that highlight how midwives around the world are helping mothers, babies, families and communities.  Some of these global messages, backed up by research and investigation include:

  • In midwife-led care, women experience less preterm births, less assisted deliveries and greater satisfaction with care.
  • Midwives change the world by caring for mothers and babies. By caring for them, midwives help ensure that women are healthy, thus contributing to a strong community and economy. When babies survive, they start growing into healthy children and adults.
  • If every childbearing woman received care with a well- educated, adequately resourced midwife, most of maternal and newborn deaths could be prevented.
  •  Investments in midwifery education as well as regulation, provision of infrastructure and information will improve access to midwifery care
  •  Midwifery services are economic and cost effective.
  •  Investment in midwives means commitment to a healthy and wealthy nation.

In many countries around the world, access to maternity care is limited by economics, social status, distance and many other factors.  Trained and qualified midwives can have a significant impact on mortality rates for mothers and babies worldwide.  For healthy, low risk women in developed countries, midwifery care is appropriate, cost effective and provides excellent outcomes for mothers and babies.

Are you or your community doing anything special to honor the midwives who work in your area?  Let us know some of the events planned.

Please join  Lamaze International, Science & Sensibility and myself in celebrating the women and men (yes, men are midwives too!) who serve as midwives to our partners, our wives, our sisters, our friends, our daughters and granddaughters all around the world.  Take a moment to thank them for their hard work and the gentle care they provide to birthing women and families.  You may want to send a customized “International Day of the Midwife” ecard to your favorite midwife, and  thank them for their contribution to healthy mothers and babies.  I am going to take a few minutes today to thank the midwives in my community for taking good care of families in my area.

Additionally, as an avid reader of books, I thought in honor of the International Day of the Midwife that I would share some of my favorite books that I have read about midwives.  I would love to hear your suggestions for future reading on this topic, as I enjoy the genre and would welcome your reading suggestions in our comments section.

Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent

Lady’s Hands, Lion’s Heart: A Midwife’s Saga - by Carol Leonard

The Birth House - by Ami McKay

The Midwife of Hope River – Patricia Harman

The Blue Cotton Gown: A Midwife’s Memoir - Patricia Harman

Arms Wide Open: A Midwife’s Journey – Patricia Harman

A Midwife’s Story  - Penny Armstrong and Sheryl Feldman

Orlean Puckett: Life of a Mountain Midwife - Karen Cecil Smith

Monique and the Mango Rains: Two Years with a Midwife in Mali - Kris Holloway

The  Midwife: A Memoir of Birth, Joy and Hard Times – Jennifer Worth

Call the Midwife: Shadows of the Workhouse – Jennifer Worth

Call the Midwife: Farewell to the East End – Jennifer Worth

A Midwife’s Tale: The Life of Martha Ballard, Based on her Diary, 1785-1812 - by Laura Thatcher Ulrich

Laboring: Stories of a New York City Hospital Midwife  by Ellen Cohen

The Midwife’s Apprentice – by Karen Cushman

Listen to Me Good: The Story of an Alabama Midwife – by Margaret Charles Smith

Babies, Home Birth, Maternal Mortality, Maternal Mortality Rate, Midwifery , , , ,

The Best Practice Guidelines: Transfer from Home Birth to Hospital – Collaboration Can Improve Outcomes

April 17th, 2014 by avatar

 By Lawrence Leeman, MD, MPH and Diane Holzer, LM, CPM, PA-C

© http://www.mybirth.com.au/

© http://www.mybirth.com.au/

On Tuesday, readers learned about the history and objectives of the Home Birth Consensus Summit, a collective of stakeholders, whose goal is to improve maternal infant health outcomes and increase collaboration between all those involved in serving women who are planning home births.  The interdisciplinary collaboration that occurs during the Summits brings representatives from many different perspectives to the table in order to improve the birth process for women and babies. You may want to start with the post “Finding Common Ground: The Home Birth Consensus Summit“ and then enjoy today’s post on the Home Birth Consensus Summit’s just released “The Best Practice Guidelines: Transfer from Home Birth to Hospital.”  Today’s post was written by Dr. Lawrence Leeman and Midwife Diane Holzer, two of the members on the HBCS Collaboration Task Force, a subgroup tasked with developing these transfer guidelines.  Share your thoughts on these new guidelines and your opinion on if you feel that they will improve safety and outcomes for mothers and babies. – Sharon Muza, Community Manager, Science & Sensibility

Leea Brady was a second-time mother whose first baby was born at home. One day past her due date, an ultrasound revealed high levels of amniotic fluid, which can pose a risk during delivery. Although she planned to have her baby at home, on the advice of her midwife, Leea transferred to her local hospital.

“I knew that we needed to be in the hospital in case anything went wrong,” said Brady. “I was really surprised when I arrived and the hospital staff told me they had read my birth plan, and they would do everything they could to honor our intentions for the birth. My midwife was able to stay throughout the birth, which meant a lot, because I had a trusting relationship with her. She clearly had good relationships with the hospital staff, and they worked together as a team.”

A recent descriptive study (Cheyney, 2014) reports that about ten percent of women who plan home births transfer to the hospital after the onset of labor. The reason for the overwhelming majority of transfers are the need for labor augmentation and other non-emergent issues. Brady’s transfer from a planned home birth to the hospital represents the ideal: good communication and coordination between providers in different settings, minimizing the potential for negative outcomes.

However, in some communities, lack of trust and poor communication between clinicians during the transfer have jeopardized the physical and emotional well being of the family, and been frustrating for both transferring and receiving providers. Lack of role clarity and poor communication across disciplines have been linked to preventable adverse neonatal and maternal outcomes, including death.(Guise, 2013,Cornthwaite, 2008) With optimal communication and cooperation among health care providers, though, families often report high satisfaction, despite not being in the location of their choice.

Recent national initiatives have been directed at improving interprofessional collaboration in maternity care.(Vedam, 2014) This is why a multi-disciplinary working group of leaders from obstetrics, family medicine, pediatrics, midwifery, and consumer groups came together to form a set of guidelines for transfer from home to hospital. The Best Practice Guidelines: Transfer from Planned Home Birth to Hospital are being officially launched today by the Home Birth Consensus Summit and will be highlighted at a series of upcoming presentations at conferences and health care facilities.

The authors of the guidelines, known as the Home Birth Summit Collaboration Task Force, formed as a result of their work together at the Home Birth Summits.

© http://flic.kr/p/3mcESR

© http://flic.kr/p/3mcESR

“Some hospital based providers are fearful of liability concerns, or they are unfamiliar with the credentials and the training of home birth providers,” said Dr. Timothy Fisher, MD, MS, at the Hubbard Center for Women’s Health in Keene, NH and an Adjunct Assistant Professor of Obstetrics and Gynecology, Dartmouth Medical School. “But families are going to choose home birth, for a variety of cultural and personal beliefs. These guidelines are the first of their kind to provide a template for hospitals and home birth providers to come together with clearly defined expectations.”

The guidelines provide a roadmap for maternity care organizations developing policies around the transfer from home to hospital. They are also appropriate for transfer from a free-standing birth center to hospital.

The guidelines include model practices for the midwife and the hospital staff. Some guidelines include the efficient transfer of records and information, a shared-decision making process among hospital staff and the transferring family, and ongoing involvement of the transferring midwife as appropriate.

“When the family sees that their midwife trusts and respects the doctor receiving care, that trust is transferred to the new provider,” said Dr. Ali Lewis, a member of the HBCS Collaboration Task Force. She became involved with the work of the committee in part because of her experiences with a transfer that was not handled optimally. “It is rare that transfers come in as true emergency. But when they do, if the midwife can tell the family she trusts my decisions, then I can get consent much more quickly, which results in better care and higher patient satisfaction.”

The guidelines also encourage hospital providers and staff to be sensitive to the psychosocial needs of the woman that result from the change of birth setting.

“When families enter into the hospital and feel as if things are being done to them as opposed to with them, they feel like a victim in the process,” said Diane Holzer, LM, CPM, PA-C, and the chair of the HBCS Collaboration Task Force. “When families are incorporated in the decision-making process, and feel as if their baby and their body is being respected, they leave the hospital describing a positive experience, even though it wasn’t what they had planned.”

The guidelines are open source, meaning that hospitals and practices can use or adapt any part of the guidelines. The Home Birth Summit delegates welcome endorsements of the guidelines from organizations, institutions, health care providers, and other stakeholders.

References

Cornthwaite, K., Edwards, S., & Siassakos, D. (2013). Reducing risk in maternity by optimising teamwork and leadership: an evidence-based approach to save mothers and babies. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(4), 571-581.

Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women’s Health.

Guise, J. M., & Segel, S. (2008). Teamwork in obstetric critical care. Best Practice & Research Clinical Obstetrics & Gynaecology, 22(5), 937-951.

Vedam S, Leeman L, Cheyney M, Fisher T, Myers S, Low L, Ruhl C. Transfer from planned home birth to hospital: inter-professional collaboration leads to quality improvement . Journal of Midwifery and Women’s Health, November 2014, In Press.

About the Authors:

leeman larry headshotDr. Lawrence Leeman, MD, MPH/Medical Director, Maternal Child Health, received his degree from University of California, San Francisco in 1988 and completed residency training in Family Medicine at UNM. He practiced rural Family Medicine at the Zuni/Ramah Indian Health Service Hospital for six years. He subsequently earned a fellowship in Obstetrics. He is board certified in Family Medicine. He directs the Family Medicine Maternal and Child Health service and fellowship and co-medical director of the UNM Hospital Mother-Baby Unit. Dr. Leeman practices the family medicine with a special interest in the care of pregnant women and newborns. He is Medical Director of the Milagro Program that provides prenatal care and maternity care services to women with substance abuse problems. Dr. Leeman is a Professor in the Departments of Family & Community Medicine, and Obstetrics and Gynecology. He is currently the Managing Editor for the nationwide Advanced Life Support in Obstetrics (ALSO) program. Areas of research include rural maternity care, pelvic floor outcomes after childbirth, family planning, and vaginal birth after cesarean (VBAC). Clinic: Family Medicine Center

Diane Holzer head shotDiane Holzer, LM, CPM, PA-C, has been a practicing midwife for over 30 years with experience in both home and birth center. She was one of the founding women who passionately created an infrastructure for the integration of home birth midwifery into the system. She sat on the Certification Task Force which led to the CPM credential and also was a board member of the Midwifery Education and Accreditation council for 13 years. She served the Midwives Alliance of North America on the board for 20 years and is the chair of the International Section being the liaison to the International Confederation of Midwives. Diane is the Chair of the Collaboration Task Force of the Home Birth Summit and currently has a home birth practice and works as a Physician Assistant doing primary health care in a rural Family Practice clinic.

Babies, Guest Posts, Home Birth, informed Consent, Maternal Mortality, Maternal Quality Improvement, Maternity Care, Midwifery, Newborns, Practice Guidelines, Transforming Maternity Care , , , , , , , ,